长效和短效达菲林对垂体降调节的作用及对体外受精-胚胎移植结局的影响

目的探讨体外受精-胚胎移植（IVF-ET）中促性腺激素释放激素激动剂（GnRH-a）垂体降调节的方式及合适剂量。方法将行IVF-ET的152例患者采用黄体期长方案进行控制性超排卵,并根据使用达菲林的剂型及剂量分为4组。A组38例,于黄体中期采用长效达菲林1.1 mg皮下注射1次;B组37例,于黄体中期采用长效达菲林1.25 mg皮下注射1次;C组37例,于黄体中期采用短效达菲林0.05 mg.d-1,每日皮下注射直至注射绒膜促性腺激素（HCG）注射日;D组40例,于黄体中期采用短效达菲林0.1 mg.d-1,月经第3-7天减至0.05 mg.d-1,每日皮下注射直至HCG注射日。结果B组的降调节时间最短、用药量最大、促性腺激素用药时间最长,与其他3组比较差异均有统计学意义（均P〈0.05）。B组HCG注射日雌二醇（E2）水平高于A组（P〈0.05）;C组HCG注射日孕酮（P）水平低于B组（P〈0.05）。4组周期获卵数、受精率、优质胚胎数、胚胎种植率及临床妊娠率比较差异均无统计学意义（均P〉0.05）。结论长效达菲林1.1 mg.d-1或短效达菲林0.05 mg.d-1的应用均能达到控制性超排卵的垂体降调节作用,并能减少促性腺激素用量及用药时间,且不影响IVF-ET结局。

Effects of Long and Short-acting Diphereline on Pituitary Down-regulation and Outcome of in Vitro Fertilization and Embryo Transfer

Objective To explore the discuss pituitary down-regulation manner and appropriate dosage of gonadotropin-releasing hormone agonist（GnRH-a） in vitro fertilization and embryo transfer（IVF-ET）.Methods Long protocol in luteal phase was performed for controlled ovarian hyperstimulation（COH） in 152 patients.According to formulation and dose of diphereline,the patients were divided into four groups：group A（n=38）：patients received subcutaneous injection of 1.1 mg long-acting diphereline once in middle of luteal phase;group B（n=37）：patients received subcutaneous injection of 1.25 mg long-acting diphereline once in middle of luteal phase;group C（n=37）：patients received subcutaneous injection of 0.05 mg·d-1 short-acting diphereline in middle of luteal phase until the injection of HCG;group D（n=40）：patients received 0.1 mg·d-1 subcutaneous injection of short-acting diphereline（0.05 mg·d-1 in the period of 3 to 7th day of menstruation） in middle of luteal phase until the injection of HCG.Results In group B,the days of down-regulation was the shortest,the dose is the biggest,and the days of Gn administration is the longest.and the other 3 groups were statistically signficant differences（P0.05）.On the day of HCG administration,E2 level in group B was higher than that in group A and P value level in group C was lower than that in group B（P0.05）.There was no significant difference in the number of retrieved oocytes and high quality embryos,fertilization rate,implantation rate and clinical pregnancy rate among the four groups（all P0.05）.Conclusion 1.1 mg long-acting diphereline and 0.05 mg·d-1 short-acting diphereline are effective on the control of pituitary down-regulation of ultra ovulation and may reduce the dosage and the time of Gn administration,but doesn＇t affect the outcome of IVF-ET.